title: Effect of N-acetylcysteine on pulmonary function in patients undergoing off-pump coronary artery bypass surgery.
abstract: BACKGROUND
  Pulmonary dysfunction related to inflammatory response and radical oxygen species remains a problem in off-pump coronary bypass graft surgery (OPCAB), especially in patients with reduced left ventricular (LV) function. The aim of this study was to evaluate the effect of N-acetylcysteine (NAC) on pulmonary function following OPCAB.
  
  
  METHODS
  Patients with LV ejection fraction ≤40% were randomly assigned to receive either a bolus of 100 mg/kg of intravenous NAC over a 15-min period immediately after anesthetic induction, followed by an intravenous infusion at 40 mg/kg/day for 24 h (NAC group, n=24), or a placebo (control group, n=24). Hemodynamic and pulmonary parameters, and the incidence of acute lung injury (PaO(2)/FiO(2)<300 mmHg) were assessed and compared.
  
  
  RESULTS
  The pulmonary vascular resistance index (PVRI) did not change during mechanical heart displacement compared with the baseline value in the NAC group while it was significantly increased in the control group. Significantly less number of patients developed acute lung injury at 2 h after the surgery in the NAC group. The other pulmonary parameters and the duration of ventilator care were all similar.
  
  
  CONCLUSIONS
  NAC demonstrated promising results in terms of mitigating the increase in PVRI during mechanical heart displacement and attenuating the development of acute lung injury in the immediate post-operative period. However, NAC could not induce a definite improvement in the other important pulmonary variables including PaO(2)/FiO(2) and Q(s)/Q(t), and did not lead to a decreased duration of ventilatory care or length of stay in the intensive care unit.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: J-C
authors.initials: JC
authors.lastname: Kim
authors.forename: S-W
authors.initials: SW
authors.lastname: Hong
authors.forename: J-K
authors.initials: JK
authors.lastname: Shim
authors.forename: K-J
authors.initials: KJ
authors.lastname: Yoo
authors.forename: D-H
authors.initials: DH
authors.lastname: Chun
authors.forename: Y-L
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000111:Acetylcysteine / Q000494:pharmacology*; D055371:Acute Lung Injury / Q000453:epidemiology / Q000517:prevention & control; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D047549:Coronary Artery Bypass, Off-Pump; D003402:Creatine Kinase / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D016166:Free Radical Scavengers / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D011652:Pulmonary Circulation / Q000187:drug effects; D012129:Respiratory Function Tests; D014655:Vascular Resistance / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D014882:Water-Electrolyte Balance / Q000502:physiology
chemical_list: D016166:Free Radical Scavengers; D003402:Creatine Kinase; D000111:Acetylcysteine